America has been weathering an opioid crisis for several years now, and things are quickly getting worse. Fentanyl, the cheap but lethal synthetic opioid that killed music legend Prince, has flooded into U.S. streets and is now taking casualties at an alarming clip. Fentanyl-caused overdose deaths jumped 426 percent from 2013 to 2014, the latest national numbers show. More recent data from individual states such as New Hampshire and Ohio confirm that overdoses are spiking.
According to the Drug Enforcement Agency, fentanyl is 50 times more potent than heroin and 100 times stronger than morphine. Unlike heroin, oxycodone, hydrocodone, and most other opioids, which are semisynthetic, fentanyl is entirely lab-created, nixing the need to grow poppies, extract opium, and treat it chemically to create the drug.
Pharmaceutical companies have been manufacturing fentanyl for decades, intended mainly for treating late-stage cancer patients and people suffering from extreme chronic pain. Because it’s so potent, even those using fentanyl patches or lollipops legally run the risk of overdose, says Dr. Andrew Kolodny, director of Opioid Policy Research at Brandeis University in Massachusetts. But since fentanyl is a tightly controlled Schedule II drug, it had not, for the most part, seeped into the nation’s illicit drug supply until very recently.
Kolodny traces fentanyl’s rise back to the 1990s and 2000s, when doctors nationwide were encouraged to dole out opioid painkillers to help improve their patients’ lives. As we now know, this resulted in nearly 3 million Americans being hooked on opioids by 2015. Kolodny says many of these people never intended to use drugs irresponsibly. Others were teens and twentysomethings who began using pills recreationally — or who were prescribed painkillers after an injury or surgery, liked the high, and then kept taking them.
After federal and state governments began cracking down on irresponsible prescribing and shutting down “pill mills,” many addicts, especially the younger ones, were forced to the black market. With demand for bootleg oxycodone and other legal painkillers at an all-time high, availability shrunk and prices skyrocketed. This pushed more and more desperate people toward cheaper, easier-to-access, more potent, more deadly heroin.
Mexican drug cartels, and even some rogue operators in the U.S., had a field day with heroin, says Kolodny. But always looking to cut production costs and boost profits, many began zeroing in on fentanyl. “Heroin is very labor intensive, weighs a lot, and takes up a lot of space to ship,” he says. “Fentanyl is not only cheaper to manufacture, it’s also easier to transport. Tiny amounts are incredibly potent, so it’s less to smuggle across the border. That’s all very attractive to cartels.”
Around 2011, cartels began buying the precursor chemicals from China and training their chemists to make fentanyl along with heroin. “Sometimes the two would get mixed,” he adds. “Also, drug dealers are now mixing fentanyl in with heroin to make that drug more potent. If they have crappy heroin that’s been cut many times, they’ll add in a little fentanyl to make it look like much better heroin.”
This is playing with fire. “If dealers don’t mix these drugs well and some bags get too much fentanyl, it’s very easy for a buyer to die of an overdose,” Kolodny says. “More recently, we’re even seeing dealers not mix it with heroin but instead just sell cut fentanyl as heroin. As a result, fentanyl is now widespread in the U.S. heroin supply. There are regions, like the Northeast, where it’s impossible to find heroin that does not contain fentanyl.”
Although fentanyl’s frightening effects are just beginning to rear their heads, Kolodny insists they are all part of the same ongoing problem. “I often hear people say that fentanyl is an entirely new, different issue,” he says. “They’ll say we first had a prescription opioid crisis, then a heroin crisis, and now a fentanyl crisis. Not so. We have an epidemic of opioid addiction. The number of addicted people has skyrocketed over the past 25 years because we overexposed our population to opioid painkillers.”
Kolodny sees two main ways to help curb this problem. “First, we need to prevent more people from getting addicted, which boils down to much more cautious prescribing,” he says. “Second, for the millions of Americans now addicted, we must make sure they can access effective treatment.” This includes improving access to treatment facilities, support groups, and medications like Suboxone, which can be a godsend for opioid addicts because it feeds the addition but does not produce euphoria. “If we don’t do these things, if drugs continue to be easier to access than quality treatment,” Kolodny warns, “we’ll keep seeing death.”